Provider Demographics
NPI:1679104475
Name:SCHMIDT, ERIC VAUGHN (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:VAUGHN
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 PORT BAY
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-9692
Mailing Address - Country:US
Mailing Address - Phone:910-578-0578
Mailing Address - Fax:
Practice Address - Street 1:1021 W HAMLET AVE
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-4564
Practice Address - Country:US
Practice Address - Phone:910-417-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102573363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical